Cyclosporin Conversion Versus Conventional Immunosuppression: Long-Term Follow-Up and Histological Evaluation

Morris, Peter J.; Allen, Richard D.; Thompson, John F.; Chapman, Jeremy R.; Ting, A.; Dunnill, M. S.; Wood, R. F.

doi:10.1016/s0140-6736(87)90233-9

Cited by 77 publications

(26 citation statements)

References 13 publications

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“…Not long afterward, a study from Oxford reported that renal function could be "normalized," with substantially less rejection, in kidney transplant recipients who converted from cyclosporineto azathioprine-based immunosuppression after 90 d (9). As in subsequent studies, histologic examination of kidneys from these patients revealed rather nonspecific changes of interstitial fibrosis, tubular vacuolization, glomerulosclerosis, and vascular hyaline arteriopathy.…”

Section: Initial Descriptions Of Cyclosporine Nephrotoxicitymentioning

confidence: 84%

“…Almost immediately, clinical thinking and practice changed: Because our most effective immunosuppressant was also nephrotoxic, a (the?) primary concern in using cyclosporine must be to reduce its impact on kidney function, particularly what was termed "chronic nephropathy" (9). Now, a quarter of a century later, cyclosporine and its newer counterpart, tacrolimus, remain our most effective and widely used immunosuppressants; we continue to deal with nephrotoxicity, struggling to find acceptable alternatives.…”

mentioning

confidence: 99%

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Chronic Calcineurin Inhibitor Nephrotoxicity

Gaston

2009

Clinical Journal of the American Society of Nephrology

113

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Use of the calcineurin inhibitors (CNI) cyclosporine and tacrolimus has revolutionized solid organ transplantation. For more than 30 yr, the transplant community has dealt with nephrotoxicity attributed to these agents. Acute renal vasoconstriction (as described by many investigators, including John Curtis and colleagues) is the unequivocal consequence of their use; chronic CNI nephropathy, although indistinct in terms of histology and pathophysiology, has become accepted as a major cause of late kidney allograft failure. This article examines clinical, laboratory, and histologic findings that evolved into a paradigm that was never fully consistent with observed outcomes and new evidence that may offer an alternative interpretation for adverse events that are attributed to CNI nephrotoxicity in kidney transplant recipients.

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Section: Initial Descriptions Of Cyclosporine Nephrotoxicitymentioning

confidence: 84%

mentioning

confidence: 99%

Chronic Calcineurin Inhibitor Nephrotoxicity

Gaston

2009

Clinical Journal of the American Society of Nephrology

113

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“…All arrived in London in advanced uraemia, two patients exhibiting among the highest serum creatinines recorded at STH in recent years -4,302pmol/l (no. 5) and 1,980pmol/1 (no. 6).…”

Section: Resultsmentioning

confidence: 99%

Ten Tanzanian transplants: problems and perspectives

Basinda

Maro²,

McLarty³

et al. 1988

Postgraduate Medical Journal

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Summary:A strategy of live related donor kidney transplantation coupled to the briefest possible preparatory period of haemodialysis was adopted as the most cost effective treatment for a selected group of 9 Tanzanian patients who received a total of 10 grafts. Patient and donor selection and preparation were carried out at Muhimbuli Medical Centre, Dar es Salaam, and the transplant procedure and first few months of follow-up were done at St. Thomas' Hospital, London. There was a high incidence of complications which drew attention to particular risk factors in the group treated. The high cost of treating these individuals emphasizes the need for research into chronic communicable and non-communicable diseases in Africa and highlights the dilemma of appropriate use of resources in serving the world's medical needs.

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“…4 However, the early withdrawal of cyclosporine at 3 months was followed by a major improvement in renal function in renal transplant recipients. 37 Therefore, it can be surmised that there is a time beyond which cyclosporine damage to the kidney is irreversible. It would also seem that, at least in the transplanted kidney, early cyclosporine effects are reversible if the cyclosporine is discontinued within 3 months.…”

Section: Cyclosporinementioning

confidence: 99%